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Annals of Obstetrics and Gynecology

Open Access | Case Report

Seborrheic keratosis of the breast mimicking

melanoma
Ouiame EL Jouari*; Sara Elloudi; Ghita Senhaji; Hanane Baybay; Fatima Zahra Mernissi
Department of Dermatology and Anatomopathology, CHU Hassan II, Morocco

*Corresponding Author(s): El Jouari Ouiame Abstract

Department of Dermatology and Anatomopathology, Seborrheic keratosis is a common skin lesion that can
CHU Hassan II, Morocco usually be recognized either clinically or dermoscopically.
However, seborrheic keratosis with atypical clinical and der-
Email: eljouariouiame@gmail.com moscopy presentation are increasingly reported. The main
objective in differential diagnosis is to discriminate sebor-
rheic keratosis from malignant conditions, and especially
melanoma, in order to determine correct treatment path-
Received: Dec 03, 2018 ways as early as possible. We report a case of a 66-year-old
Accepted: Jan 03, 2019 woman with an atypical clinically and dermoscopy pigment-
Published Online: Jan 04, 2019 ed lesion of the breast, mimicking melanoma.

Journal: Annals of Obstetrics and Gynecology

Publisher: MedDocs Publishers LLC
Online edition: http://meddocsonline.org/
Copyright: ©EL Jouari O (2018). This Article is distributed
under the terms of Creative Commons Attribution 4.0
International License

Keywords: Seborrheic keratosis; Melanoma

Introduction Case presentation

Seborrheic Keratosis is one of the most commonly observed A 66-year-old woman, with 6-year history of an ischemic ce-
benign skin tumours in everyday clinical practice. In their typi- rebral stroke complicated by left hemiplegia. The patient’s med-
cal form, it appears as variably pigmented patches and nodules, ical and family history of cutaneous diseases was negative.
often affecting elderly people [1]. Despite an often unsightly
She presented 8 months’ history of an asymptomatic bleed-
appearance which can be frightening for the patient, a dermo-
ing pigmented lesion of the right breast. Dermatological ex-
scopic examination usually enables a clear-cut diagnosis of the
amination revealed a 3 cm black, multilobed, pedicled tumor,
disease with typical features [2]. However, Seborrheic keratosis
firm in consistency with well-defined borders on erythematous
with atypical dermoscopy presentation are increasingly report-
background of the right breast (Figure 1). Dermoscopy showed
ed. These lesions sometimes mimic melanoma, thus compli-
heterogeneous pigmentation, linear vessels and brown globules
cating the differential diagnosis [3]. We aim to present a non-
(Figure 2) with the absence of comedo-like openings. From the
typical case of seborrheic keratosis with atypical dermoscopy
clinical and dermoscopical point of view the lesion appeared
presentation, observed as a pigmented lesion of the breast
suspicious. The diagnosis of melanoma was strongly being made
mimicking melanoma.

Cite this article: EL Jouari O, Elloudi S, Senhaji G, Baybay H, Mernissi FZ. Seborrheic keratosis of the breast mim-
icking melanoma. Ann Obstet Gynecol. 2019; 2(1): 1006.

1

through the history, clinical examination, dermoscopic features
and the rapid growth of the tumor. A total excision of the lesion
was performed. To our surprise, histopathological examination
showed exophytic proliferation of epidermal cells. The lesion ex-
hibited papillomatosis, hyperparakeratinization, acanthosis and
deep, keratin-filled invaginations. Keratotic invaginations with
intraepithelial keratin cysts were present. Melanin pigmenta-
tion was observed in the basal layer. The dermis exhibited colla-
gen fibers, blood vessels and moderate inflammatory infiltrate
(Figures 3,4). At 7 months of decline, no recurrence was noted.
Figure 1: A 3 cm black multilobed pedicled tumor of the right
breast.
Figure 2: Dermoscopy showing a heterogeneous pigmentation,
linear vessels and brown globules.
Figure 3: Histologic findings: pseudohorn cysts in the epidermis
opened to the surface of the lesion and intraepidermal cysts.
Annals of Obstetrics and Gynecology
MedDocs Publishers
Figure 4: Histologic findings: papillomatous surface of the epi-
dermis with enlarged capillaries of the dermal papillae.
Discussion
Seborrheic keratosis is a common benign tumor, the diagnosis is, in
general, a clinical one.
It appears as variably pigmented patches and nodules, often af-
fecting elderly people [1]. But in some cases, the differential diagnosis
between pigmented seborrheic keratosis and malignant melanoma
is difficult [4]. Although, Dermoscopy is a non-invasive helpful tool
in diagnosis of seborrheic keratosis [5]. Typical dermoscopic features
that we commonly use to identify seborrheic keratosis, were system-
atically described and included in a dermoscopic algorithm in 2003 by
Argenziano et al, such as multiple milia-like cysts, comedo-like open-
ings, fissures, finger-print structures and sharply demarcated borders
[2]. A series of additional dermoscopic criteria to increase diagnostic
accuracy, underlining fissures, hairpin vessels, sharp demarcation and
moth-eaten borders were proposed. Later, Scope and al observed that
some typically melanocytic dermoscopic features, such as pigmented
network, aggregated globules, streaks and homogeneous blue colour,
were also present in seborrheic keratosis and other non- melanocytic
lesions [3]. As a consequence, when characteristics features of sebor-
rheic keratosis are observed at dermoscopy, a differential diagnosis is
simplified. In our case, we believe that the original misdiagnosis result-
ed because of the absence of this findings at dermoscoy. Reflectance
confocal microscopy is also an optimal non-invasive examination for
early differential diagnosis of seborrheic keratosis with atypical der-
moscopy presentations. Therefore, It may be able to assist in differ-
ential diagnosis and avoid unnecessary excisions [3]. Histopathology
should remain mandatory for seborrheic keratosis with atypical der-
moscopy and without a clear differentiation from other malignancies
at dermoscopy [6]. The management of these atypical seborrheic kera-
tosis remains undefined, often requiring a final excision of the lesion
to reach a correct diagnosis [7]. To complicate the picture, melanomas
mimicking seborrheic keratosis have also been reported [8]. Interest-
ingly, the current case shows that seborrheic keratosis can present a
challenging clinical appearance, and even expert dermatologists can
misdiagnose these difficult cases.
Conclusion
We showed one of the rare clinical and dermoscopical pictures of
seborrheic keratosis which suggested melanoma. A histopathological
examination is crucial in confirming the diagnosis.
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